Treatment of Unresectable Hepatoblastoma with Liver Transplantation in the Pediatric Population

Molmenti, Ernesto P.; Wilkinson, Krissy; Molmenti, Hebe; Roden, Jay S.; Squires, Robert H.; Fasola, Carlos G.; Tomlinson, Gail E.; Nagata, D.; Damico, Lisa A.; López, Mariana; Savino, Leo M.; Marubashi, Shigeru; Sanchez, Edmund Q.; Goldstein, Robert M.; Levy, Marlon F.; Andrews, Walter S.; Andersen, John M.; Klintmalm, Göran B.

doi:10.1034/j.1600-6143.2002.20607.x

Cited by 55 publications

(27 citation statements)

References 14 publications

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“…The actual 1-and 5-year survival rates are 78.6% and 65.5%, respectively, which are comparable with survival rates following both radical resection and deceased liver transplantation (6,9,(15)(16)(17)(18). Four children (28.6%) died from tumor recurrence after LDLT.…”

Section: Discussionsupporting

confidence: 56%

Living‐Donor Liver Transplantation for Hepatoblastoma

Kasahara

Ueda

Haga

et al. 2005

American Journal of Transplantation

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Hepatoblastoma is the most common malignant liver tumor in children. Recently, liver transplantation has been indicated for unresectable hepatoblastoma. We retrospectively reviewed 14 children with a diagnosis of hepatoblastoma who had undergone living-donor liver transplantation (LDLT) at Kyoto University Hospital. During the period from June 1990 to December 2004, 607 children underwent LDLT. Of these interventions, 2.3% were performed for hepatoblastoma. Based on radiological findings, the pre-treatment extent of disease (PRETEXT) grouping was used for pretreatment staging of the tumor. There were grade III in seven patients and grade IV in seven patients. Thirteen patients received chemotherapy, and seven underwent hepatectomy 11 times. Immunosuppressive treatment consisted of tacrolimus monotherapy in 11 patients. Actuarial 1-and 5-year graft and patient survival rates were 78.6% and 65.5%. The poor prognostic factors were macroscopic venous invasion and extrahepatic involvement with 1-year and 5-year survival rates of 33.0% and 0%. Pediatric patients without these factors showed an acceptable 5-year survival rate of 90.9%. LDLT provides a valuable alternative with excellent results in children with hepatoblastoma because it allows optimal timing of the liver transplantation, given the absence of delay between the completion of chemotherapy and planned liver transplantation.

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Section: Discussionsupporting

confidence: 56%

Living‐Donor Liver Transplantation for Hepatoblastoma

Kasahara

Ueda

Haga

et al. 2005

American Journal of Transplantation

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“…Because patients who receive CFV may develop secondary malignancies, and because immunosuppressive therapies necessary to control graft rejection after OLT lower the threshold for lymphoproliferative disorders, then sound rationale exists to limit chemotherapy exposure to patients who are deemed persistently unresectable when the decay plateau has been reached. However, despite encouraging results accumulating for OLT in the surgical algorithm for hepatoblastoma, our data regarding margin status continue to support aggressive partial hepatectomy, given limited organ resources and the need for life-long immunosuppression (18, 19). …”

Section: Discussionmentioning

confidence: 86%

Defining hepatoblastoma responsiveness to induction therapy as measured by tumor volume and serum α-fetoprotein kinetics

Lovvorn

Ayers

Zhao

et al. 2010

Journal of Pediatric Surgery

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Purpose Hepatoblastoma is commonly unresectable at presentation, necessitating induction chemotherapy before definitive resection. To refine the paradigm for timing of resection, we questioned whether a plateau in hepatoblastoma responsiveness to neoadjuvant therapy could be detected by calculating tumor volume (TV) and serum α-fetoprotein (sAFP) kinetics. Methods To calculate TV and sAFP as measures of treatment responsiveness over time, infants having initially unresectable epithelial-type hepatoblastomas were identified at a single institution (1996-2008). Effects of therapy type, therapy duration, and lobe of liver involvement on TV, sAFP, margin status, and toxicity were analyzed. Results Of 24 infants treated for epithelial-type hepatoblastoma during this interval, 5 were resected primarily, and 15 had complete digital films for kinetics analysis. Both TV and sAFP decreased dramatically over time (p<0.0001). No statistically significant difference in mean TV or sAFP was detected after chemotherapy cycle 2. Left lobe tumors had greater presenting levels of and significantly slower decay in sAFP compared to right lobe tumors (p=0.005), although no statistically significant differences in TV existed between liver lobes. Resection margins did not change with therapy duration. Conclusions Measuring TV and sAFP kinetics accurately reflects hepatoblastoma responsiveness to induction therapy. Treatment toxicities may be reduced by earlier resection and tailoring of chemotherapeutic regimens.

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“…Other single-center studies have reported similar success of OLT for unresectable HB [10][11][12]14]. In 2002, Pimpalwar and colleagues [14] showed 100% survival in patients who were chemoresponders and subsequently underwent OLT.…”

Section: Discussionmentioning

confidence: 88%

“…Despite this progress, disease-free survival for both HB and HCC is dependent upon resectability and complete surgical resection is essential for cure [5,6]. For patients with unresectable disease limited to the liver after chemotherapy, total hepatectomy and orthotopic liver transplantation (OLT) have become a recognized treatment option [7][8][9][10][11][12].…”

mentioning

confidence: 99%